接受抗抑郁药治疗的双相情感障碍 II 型抑郁门诊患者中出现的治疗诱发躁狂的临床和精神病理学特征。
Clinical and psychopathological features associated with treatment-emergent mania in bipolar-II depressed outpatients exposed to antidepressants.
机构信息
New York State Psychiatric Institute, Columbia University, NYC, NY, USA; Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
Federico II University, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, Naples, Italy.
出版信息
J Affect Disord. 2018 Jul;234:131-138. doi: 10.1016/j.jad.2018.02.085. Epub 2018 Mar 1.
BACKGROUND
Treatment-emergent affective switch (TEAS), including treatment-emergent mania (TEM), carry significant burden in the clinical management of bipolar depression, whereas the use of antidepressants raises both efficacy, safety and tolerability concerns. The present study assesses the prevalence and clinical correlates of TEM in selected sample of Bipolar Disorder (BD) Type-II (BD-II) acute depression outpatients.
METHODS
Post-hoc analysis of the clinical and psychopathological features associated with TEM among 91 BD-II depressed outpatients exposed to antidepressants.
RESULTS
Second-generation antipsychotics (SGA) (p = .005), lithium (≤ .001), cyclothymic/irritable/hyperthymic temperaments (p = ≤ .001; p = .001; p = .003, respectively), rapid-cycling (p = .005) and depressive mixed features (p = .003) differed between TEM cases vs. TEM controls. Upon multinomial logistic regression, the accounted psychopathological features correctly classified as much as 88.6% of TEM cases (35/91 overall sample, or 38.46% of the sample), yet not statistically significantly [Exp(B) = .032; p = ns]. Specifically, lithium [B = - 2.385; p = .001], SGAs [B = - 2.354; p = .002] predicted lower rates of TEM in contrast to the number of lifetime previous psychiatric hospitalizations [B = 2.380; p = .002], whereas mixed features did not [B = 1.267; p = ns].
LIMITATIONS
Post-hoc analysis. Lack of systematic pharmacological history record; chance of recall bias and Berkson's biases. Permissive operational criterion for TEM. Relatively small sample size.
CONCLUSIONS
Cyclothymic temperament and mixed depression discriminated TEM between TEM cases, although only lithium and the SGAs reliably predicted TEM grouping. Larger-sampled/powered longitudinal replication studies are warranted to allow firm conclusions on the matter, ideally contributing to the identification of clear-cut sub-phenotypes of BD towards patient-tailored-pharmacotherapy.
背景
治疗诱发的情感转换（TEAS），包括治疗诱发的躁狂（TEM），在双相情感障碍抑郁的临床管理中带来了重大负担，而抗抑郁药的使用既提高了疗效，又提高了安全性和耐受性。本研究评估了在选定的双相情感障碍 II 型（BD-II）急性抑郁门诊患者样本中 TEM 的患病率和临床相关性。
方法
对 91 名接受抗抑郁药治疗的 BD-II 抑郁门诊患者的 TEM 相关临床和精神病理学特征进行事后分析。
结果
第二代抗精神病药（SGA）（p =.005）、锂（≤.001）、环性/易怒/高敏气质（p = ≤.001；p =.001；p =.003）、快速循环（p =.005）和抑郁混合特征（p =.003）在 TEM 病例与 TEM 对照之间存在差异。多元逻辑回归分析表明，所考虑的精神病理学特征正确分类为多达 88.6%的 TEM 病例（91 例总体样本中的 35 例，或样本的 38.46%），但无统计学意义[Exp（B）=.032；p = ns]。具体而言，锂[B = - 2.385；p =.001]、SGA [B = - 2.354；p =.002]可降低 TEM 发生率，而一生中以前住院的次数[B = 2.380；p =.002]则增加了 TEM 发生率，而混合特征则没有[B = 1.267；p = ns]。
局限性
事后分析。缺乏系统的药物治疗史记录；存在回忆偏倚和 Berkson 偏倚的可能性。TEM 的操作性标准较为宽松。样本量相对较小。
结论
环性气质和混合性抑郁可区分 TEM 病例，尽管只有锂和 SGA 可靠地预测了 TEM 分组。需要进行更大样本量/更大功率的纵向复制研究，以便就该问题得出明确结论，理想情况下有助于确定针对患者的个体化药物治疗的明确的双相情感障碍亚表型。
Zotero 插件